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Improving Stroke Care in Canada

A major Canadian study on the quality of stroke care, released by the Canadian Stroke Network (CSN) in June, finds that significant work still needs to be done to improve prevention, treatment and recovery from stroke. Funded and authored by the Canadian Stroke Network, This link will take you to another Web site The Quality of Stroke Care in Canada is the first national study to closely examine stroke care in Canada.

The Quality of Stroke Care in Canada could not be timelier,” says Dr. Robert Côté, Chair of the study’s national steering committee and a Professor at McGill University. “The results of this study should be used to prioritize investments in stroke care and improve and monitor the quality of stroke care for all Canadians. Stroke is one of the leading causes of death and the main cause of neurological disability in Canada. The study will be of great value to our health system.”

CSN collected data representing 38,210 patients admitted with stroke from 295 hospitals across Canada over the period 2008-2009.The objectives of the study were to compare the current stroke care in Canada with best practice recommendations; to identify gaps in stroke care; to highlight economic and societal impacts of improved stroke care delivery; and to make recommendations for improving stroke care.

The study looked at the quality of stroke care provided in emergency response, in-hospital care and in rehabilitation and recovery. Anonymous information from patients’ records was used and included time of stroke symptom onset, timeliness of emergency medical system access, treatment received in the emergency department, acute inpatient care and information related to patient discharge from the acute care hospital.

“The study’s findings and recommendations are a ‘call to action’ to the Canadian stroke care community,” says Dr. Moira Kapral, a national steering committee member and Associate Professor, Faculty of Medicine and Department of Health, Policy Management and Evaluation at the University of Toronto. “There needs to be a greater emphasis on improving the public’s awareness about the early signs and symptoms of stroke and the importance of calling 9-1-1 and having an ambulance bring them to hospital immediately.”

The study found that Canadians need to be better informed about the severity of stroke and what critical steps need to be taken when experiencing stroke symptoms. Two thirds of stroke patients admitted to hospital did not arrive at hospital within 3.5 hours, a crucial time for receiving the best possible stroke care. Many patients arrived much later—39 percent of all stroke patients arrived at hospital more than 12 hours after symptom onset.

When patients arrive at hospital, they are not treated fast enough. Only 40 percent of patients who arrived within 3.5 hours of symptom onset received a CT (computed tomography) or MRI (Magnetic resonance imaging) scan within an hour of arrival. Stroke patients need greater access to stroke units. The study also found that only 23 percent of stroke patients in Canada are treated in a specialized stroke unit while in hospital.

Overall patients receive good care in hospital but aspects of stroke care need to be significantly improved.  Only 12 percent of ischemic stroke patients admitted to a hospital with the capability to administer the important clot dissolving drug tPA were treated with the drug.  Based on tPA rates at some of Canada’s top stroke centres, the target number could be triple the current rate for those ischemic strokes that arrive within the 3.5-hour window.

Telestroke could save lives, but it is not being widely used. The Telestroke network allows real-time assessment of patients who live in rural settings or who are admitted to smaller hospitals, yet less than 1 percent of stroke patients are benefiting from this service.

Access to rehabilitation is vital. Patients with moderate to severe stroke (30-40 percent of all cases) benefit most from rehabilitation in a specialized facility. Only 37 percent of moderate to severe strokes cases are discharged to a rehabilitation facility.

“We are extremely pleased with the results of the study because it illustrates what can be achieved in stroke care in Canada. If Canada invests now in innovative and sustainable stroke care systems and programs—we will achieve real benefits such as saving more lives and reducing the impact of stroke,” says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network.

Canadian Stroke Network

This link will take you to another Web site The Canadian Stroke Network is one of Canada’s Networks of Centres of Excellence. It brings together more than 100 of Canada’s leading scientists and clinicians from 24 universities and includes partners from industry, the non-profit sector, provincial and federal governments. The Canadian Stroke Network is dedicated to decreasing the physical, social and economic consequences of stroke on the individual and on society.

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